Making the Case for Lifestyle Medicine

A Summary of Success with Lifestyle Medicine on a Cohort of 45 Patients with Chronically Uncontrolled Type 2 Diabetes

 Patients with chronically uncontrolled diabetes who are referred to endocrinology are often taking several medications and have trouble adhering to their care regimen. A Lifestyle Medicine intervention is one approach that can help change the trajectory of their disease course.

Dr. Gebreselassie (Gebre) Nida, a Cone Health endocrinologist (also board certified in Lifestyle Medicine), began incorporating this evidence based therapeutic option in the care of several of his patients and the results are very encouraging, as indicated by about 175 (and counting) patients returning with impressive outcomes.

Here is the implementation brief for the first 45 patient-cohort. This Lifestyle Medicine intervention was conducted at Reidsville Endocrinology Associates practice in Reidsville, NC. It involved 10-15 minutes of lifestyle coaching following a traditional endocrinology patient visit. This included verbally discussing a packet of information that explains the six pillars of Lifestyle Medicine. The selection criteria for this intervention included having a high medication burden, chronically uncontrolled diabetes markers, being receptive to lifestyle change, and having basic literacy and visual acuity. Key markers such as hemoglobin A1c, body weight, and cholesterol levels were taken from initial referral data and 6-12 months after the initial intervention with ongoing coaching during the intervening visits. Some of the patients are already seen for 3 visits over a year.

Results:  A total of 45 patients received the Lifestyle Medicine intervention and were seen again for 2-3 visits 3-4 months apart. There was an average of a 2.85-point drop in hemoglobin A1c [10.15% to 7.3%] for 45 patients. Body weight was measured for 43 patients before and after the intervention. These patients achieved an average weight loss of 18 pounds. LDL (low density lipoprotein also known as “bad cholesterol”) was measured after the intervention for 28 patients and their LDL decreased by an average of 45.3 mg/dL. There was also significant improvement in hypertension as well as increased engagement in self-care.  Additionally, de-prescription of medications for diabetes, high blood pressure, and/or high cholesterol was achieved for 60% of the patients. All the patients achieved multiple goals simultaneously, but a few achieved especially noteworthy changes in health status such as reversal of erectile dysfunction, reversal of hypogonadism in one patient, improvement in MASLD (formerly non-alcoholic fatty liver disease), and potential reversal of sleep apnea, as indicated by two patients not needing their CPAP machines anymore to get restorative sleep. Three patients quit smoking successfully.

Conclusion: Significant improvements were observed across all metrics examined, including hemoglobin A1c, body weight, LDL, and number of prescriptions after the Lifestyle Medicine intervention. Especially noteworthy is the fact that these results are achieved with no additional prescriptions and the avoidance of further prescriptions for these patients is paramount. The results suggest that a Lifestyle Medicine intervention is effective in endocrinology practice and should be expanded to all patients meeting eligibility criteria. Lifestyle Medicine is a comprehensive better way of healing and a cost-effective way to keep people healthy.

Making the case for Lifestyle Medicine

In a world inundated with quick fixes and instant gratification, the concept of Lifestyle Medicine stands as a beacon of hope and resilience. It beckons us to return to the fundamentals of health and well-being, reminding us that our daily choices profoundly impact our quality of life.

Lifestyle Medicine is a medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic lifestyle related conditions including, but not limited to, cardiovascular diseases, type 2 diabetes, dementia, obesity, and most cancer types.

Lifestyle Medicine encapsulates a holistic approach to health—one that recognizes the intricate interplay between our habits, environments, and overall wellness. It emphasizes the power of prevention, acknowledging that many chronic diseases plaguing our society are, in large part, preventable through mindful living. When Lifestyle Medicine is appropriately dosed, it has the power to put some of these conditions into remission- particularly type 2 diabetes.

Lifestyle Medicine is the foundation for a redesigned, value-based, and equitable healthcare delivery system, leading to a whole person health.

At its core, Lifestyle Medicine advocates for simple yet transformative changes in our daily routines. It champions the importance of wholesome nutrition, regular physical activity, stress management, restorative sleep, avoiding risky and toxic substances, and meaningful social connections. These 6 pillars- used to practice Lifestyle Medicine- serve as the cornerstone of a vibrant and fulfilling existence, nurturing both our bodies and minds.

In embracing Lifestyle Medicine, we empower ourselves to take charge of our health journey. We shift our focus from merely treating symptoms to addressing root causes, from reactionary measures to proactive strategies. We become architects of our own well-being, sculpting healthier habits that resonate with our values and aspirations.

Moreover, Lifestyle Medicine fosters a profound sense of interconnectedness—with ourselves, with each other, and with the world around us. It encourages us to cultivate mindfulness and gratitude, fostering a deeper appreciation for the precious gift of life. It reminds us that our well-being is intricately woven into the fabric of our communities and ecosystems, calling for collective action and solidarity.

American College of Lifestyle Medicine

As the nation’s only medical professional association representing the interdisciplinary field of Lifestyle Medicine, the American College of Lifestyle Medicine (ACLM) represents a galvanized force for change; members are united in their dedication to identify and eradicate the root causes of chronic disease, with the clinical outcome goal of health restoration.  Formal education and training simply do not include foundational tactics that address the root causes of many chronic conditions.  ACLM closes the gap in evidence-based education in Lifestyle Medicine across the spectrum of pre- and post-professional training.  Along with training and support of its members in their individual practices, ACLM advocates lifestyle medicine as the first and optimal whole-person treatment option for all people, mitigating much of the non-communicable, chronic disease epidemic.

In collaboration with American Board of Lifestyle Medicine (ABLM), ACLM advocates, supports, and promotes the education and certification of clinicians, healthcare leaders, and healthcare systems with the specialty of Lifestyle Medicine. Lifestyle Medicine certified clinicians emphasize and specialize in health restoration, as opposed to a sole focus on disease management. The college is growing rapidly in membership, in impact, and scope. Most health professionals and leaders can join as members.

Lifestyle Medicine can address up to 80% of chronic diseases burden and cost. A Lifestyle Medicine approach to population care has the potential to arrest the decades-long rise in the prevalence of chronic conditions and their burdensome costs.

 Patient and provider satisfaction often results from a Lifestyle Medicine approach, which strongly aligns the field with the Quintuple Aim of:

    1) Better Health Outcomes                                             2) Lower Cost      

    3) Improved Patient Satisfaction                                    4) Improved provider well-being, and      

    5) Advancement of health equity, in addition to its alignment with planetary health.     

As we embark on this journey towards optimal health, let us remember that transformation is not instantaneous nor linear. It is a gradual, iterative process—one that requires patience, perseverance, and self-compassion. Each small step we take towards healthier living is a testament to our resilience and commitment to vitality.

In closing, let us reaffirm our dedication to embracing Lifestyle Medicine as a guiding principle in our lives. Let us inspire and support one another on this shared path towards greater health, happiness, and fulfillment. Together, let us harness the transformative power of Lifestyle Medicine to create a world where every individual can thrive. 

Thank you.  Gebre Nida, MD, FACE, DipABLM.